Last month we took a critical look at "AAOS: Strong recommendation for "bioinductive tendon implants to augment rotator cuff repair". Please take a moment to review it.
Recently, the authors of No Short-term Clinical Benefit to Bovine Collagen Implant Augmentation in Primary Rotator Cuff Repair: A Matched Retrospective Study used a single surgeon, minimum two year retrospective, matched, comparative study of patients who underwent primary arthroscopic repair of partial or full-thickness rotator cuff tears to determine (1) whether the proportion of patients undergoing re-operation for postoperative stiffness and inflammation differed between patients having cuff repair with a bovine collagen implant (Regeneten) and patients having cuff repair without the implant, (2) whether short-term patient-reported outcomes differed between the two groups, and (3) whether the proportion of patients receiving postoperative methylprednisolone prescriptions and corticosteroid injections differed between the two groups.
They found that a greater proportion of patients in the bovine collagen implant group (9% [4 of 47]) underwent reoperation for inflammation and stiffness than in the control group (0% [0 of 94]). At minimum 2-year follow-up, patients receiving the Regeneten implant did not have better reported outcomes: American Shoulder and Elbow Surgeon score (81 ± 24 implant versus 85 ±19 control, SSV (79 ± 24 implant versus 85 ± 18 control), VAS score for pain (2.0 ± 2.9 implant versus 1.5 ± 2.3 control). The cohorts did not differ in the proportion who received postoperative corticosteroid injections or methylprednisolone prescriptions.
They concluded that "at minimum 2-year follow-up, patients undergoing primary arthroscopic rotator cuff repair with bovine collagen implant augmentation had a greater proportion of re-operation due to inflammation and stiffness compared with patients who did not receive the implant. Furthermore, the implant offered no benefit in patient-reported outcomes or need for postoperative corticosteroid injections or methylprednisolone prescriptions. Because of the lack of clinical benefit and potential increase in postoperative complications, we recommend against the use of these bovine collagen implants unless high-quality randomized controlled trials are able to demonstrate their clinical effectiveness, cost-effectiveness, and overall safety."
The authors of Effect of Porcine-Derived Absorbable Patch-Type Atelocollagen for Arthroscopic Rotator Cuff Repair compared standard rotator cuff repair to repair with a type-I atelocollagen absorbable patch derived from pigs (RegenSeal) in patients having rotator cuff repair. For the atelocollagen group, before securing the lateral anchors, porcine-derived absorbable patch-type atelocollagen was inserted between the footprint and the tendon. They found no significant differences in pre to postoperative improvement in Constant Score, pain, other functional scores, and range of motion between the groups at 1 year postoperatively.
The authors Acellular Collagen Matrix Patch Augmentation of Arthroscopic Rotator Cuff Repair Reduces Re-TearRates: A Meta-analysis of Randomized Control Trials pooled outcomes of studies found that in 5 studies with 156 patients augmented with ACMP and 151 controls, the average final Constant score was 90 in the ACMP group and 87 in controls. This difference did not exceed the minimal clinically important difference for the Constant score (10 points). In 3 studies with 64 patients augmented with ACMP and 61 controls, the average American Shoulder and Elbow Surgeons Score score was 87 in the ACMP group and 82 in controls. This difference did not exceed the minimal clinically important difference for the ASES (20 points).
See also:
AAOS: Strong recommendation for "bioinductive tendon implants to augment rotator cuff repair"
The value of the Regeneten bioinductive implant in managing rotator cuff disease: what does the literature say?
Comment: A strong recommendation from our Academy could conceivably put patients and surgeons at risk if this recommendation were not followed. In the case of rotator cuff repair, evidence that porcine or bovine patches are of clinically significant benefit in terms of patient-reported outcomes seems to be lacking. Until more convincing data become available, it may be appropriate to consider modifying the recommendation for the use of these implants in cuff repair.
Worthy of discussion
Ravens and Red Tailed Hawk
Union Bay Natural Area
2020
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link)
The total shoulder arthroplasty (see this link)
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).